Pulpotomies for Irreversible Pulpitis? The Rise of Vital Pulp Therapy - PDP133

This podcast will change the way you think about pulpotomies and endodontics in general. Georg Benjamin explains that severe throbbing pain (or classic signs of IRREVERSIBLE PULPITIS) does not necessarily mean a pulpectomy is needed.
Instead, we can consider a pulpotomy for permanent teeth to preserve radicular pulp tissue and maintaining a vital tooth!
For our German Protruserati, check out Georg's Dental Podcast: www.saurezaehn...
Highlights of this episode:
0:00 Introduction
2:02 Protrusive Dental Pearl
4:47 Georg Benjamin’s Dental Podcast Journey
7:10 Georg’s Endodontic Journey
11:46 Case Discussion: Pulpal Diagnosis
16:17 Pulpotomy
19:37 Direct Pulp capping
22:26 Indirect Pulp Cap
23:58 Pulpotomy Protocol
26:59 Classifications of Pulpotomy
30:52 Bleeding Time Protocol
33:31 Patient Communication
35:34 Treatment Decision-Making
38:57 Success rate of pulpotomy
41:10 Early and Late failures
42:30 Long-term treatment
45:14 Unhealthy pulp
48:08 Materials and Products for Pulpotomy
50:54 Leaving carious dentine as base
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[@Cavanho]

Oo this was 32 hours late, had a patient with irreversible pulpitis secondary to cracked tooth syndrome…. Got very close to pulp chamber but cleared the crack and some caries… decided hold on this might not need an RCT so packed some ledermix and cotton pledget etc. in hindsight should’ve gone CaOH

[@protrusive]

Hi Cavan! Did you use the ledermix as an indirect pulp cap? Or did you expose?

[@Cavanho]

@@protrusive
Ok let’s do the full story:
Sharp ‘brain freezing’ pains while in motion: in the car /on the bus
UR6 stained palatal fissure with a tiny spot of possibly active caries
Endo frost test normal in UR567, perhaps just slightly lingering on UR6
Non TTP
Pain sensation recreated with pressure applied to mesiopalatal cusp UR6
Transillumination detection of poss fracture line running around the whole MP cusp
Articaine buccal + palatal infiltration
Caries removal - woah that tiny spot actually went down really far
Some visible crack-lines chased about 2mm
Followed the caries down but patient starts getting sensitivity. All caries removed by this point. I still want to go deeper and do a pulpotomy at least
2 cartridges and 10mins later, still sensitive. All caries removed, I can just about see the pulp horn. Too sensitive to continue. I just go CHX, ledermix, cotton pellet, GIC. Review in 1 week
Called her today (>24 hours now) says it’s sooo much better, but there is still a tiny bit of an ache sometimes.
Reckon I should’ve used hypochlorite, and gone deeper and got some blood. There was some dentine there I was afraid to remove and praying for the diffusion of ledermix 🥲

[@monicaravi4818]

Should sodium hypochlorite be used after the bleeding has stopped or to apply over the bleeding pulp?

[@miradehoca9930]

Yes ! Love this episode's subject, very interesting !
Thanks Jaz.

[@protrusive]

thank YOU doc!

[@ChristosAthanasoulis]

Great episode!!

[@nazanin4508]

Thanks for this interesting topic!which material is better for pulpotomy in permanent tooth? Cem cement, dycal, light curing dycal, zonalin(zoe)

[@Elias-yx9gx]

Hi, Which pulpotomy materials is the longest lasting option?

[@nazanin4508]

can we use ferric sulfate instead of hypochlorite in permanent tooth?

[@Al_070]

What do you mean by freshly mixed CaOH vs dycal; as dycal requires mixing of the base and catalyst?

[@protrusive]

I'm not sure about the freshly mixed part either actually, but dycal is a setting material - we want to place NON setting calcium hydroxide in canals

[@sarah702]

Thank you very much for this amazing episode. I have a question, can we use the same methods and procedure for primary teeth? And can we use sodium hypochlorite instead of ferric sulfate ? My practice doesn’t have that and we have plenty cases of pulpotomy everyday.

[@protrusive]

I asked my wife (doing her MSc in Paeds) and she said MTA/Ferric sulfate - NOT hypochlorite

[@ByeliyMyech]

I NEVER ever heard of using hypochloride for pulpotomys, only IPC and DPC disinfecting the cavity and pulpectomy?!!

[@ohokay7498]

Would this work for cracked tooth syndrome?

[@protrusive]

the way I see it the best endo is no endo. If one can manage CTS without pulpal entry then that would be ideal.

[@ohokay7498]

@@protrusive thank you. Did a composite filling, but unfortunately tooth still has pain on biting tooth slooth

[@protrusive]

@@ohokay7498 reduce the cusps - temporary direct overlay or it is an extensive composite go for onlay/crown.